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«November 2013 You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open ...»

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Effective Clinical and

Financial Engagement

A best practice guide for the NHS

November 2013

You may re-use the text of this document (not including logos) free of charge in any format or

medium, under the terms of the Open Government Licence. To view this licence, visit

www.nationalarchives.gov.uk/doc/open-government-licence/

© Crown copyright

Published to gov.uk, in PDF format only.

www.gov.uk/dh

2

Effective Clinical and

Financial Engagement

A best practice guide for the NHS 3 Contents Foreword

1. Introduction

2. Definitions and benchmarking

3. Characteristics of effective engagement

4. Self-assessment tool

5. Practical suggestions and enabling factors to promote effective engagement.............. 19

6. Best practice inspiration

7. Resources

Annex A: Achievements – Development of clinical and financial engagement in the NHS34 Annex B: Acknowledgements

Annex C: Recommendations of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry which are pertinent to effective clinical and financial engagement............. 36 4 A Guide to Effective Clinical and Financial Engagement Foreword Effective engagement between NHS clinicians and finance professionals has always been important and never more so than now as the NHS seeks to improve the quality of care for patients while becoming more productive and efficient.

Across England, NHS organisations are facing the challenge of delivering their commitments under the NHS Outcomes Framework within current financial constraints.

Finance managers have a critical role to play in this challenge but they cannot deliver it alone. It is clinicians – doctors, nurses and allied health professionals – who commit NHS resources and who need a greater understanding of the financial consequences of their actions.

In this context, many questions have been raised in the NHS. Not least, what do clinical and financial professionals need to be able to develop more productive partnerships? What are the barriers which the NHS needs to overcome, the key levers for engagement and the best practice steps for a way forward?

This best practice guide has been developed to answer these questions and to help promote and create engagement on a large scale between clinicians and finance professionals. It aims to help NHS organisations to seize the opportunity provided by the current financial challenges to develop new partnerships between their clinical and finance teams which are capable of cocreating added value.

The Department of Health has worked with a number of organisations and individuals to develop this guidance. Now the onus is on all clinical and financial colleagues to use it to make a difference by delivering high quality, value-based healthcare in the NHS.

I am grateful for the support and advice I’ve received on the journey to lead the development of more effective engagement between clinical and finance professionals in the NHS, in particular from: Richard Douglas (Director General, Strategy and NHS Finance, Department of Health), Professor Sir Bruce Keogh (Medical Director, NHS England), Jim Easton (former National Director for Transformation, NHS England), David Flory (Chief Executive, NHS Trust Development Authority), and senior colleagues from the Healthcare Financial Management Association (HFMA) and Monitor. Special thanks also go to the Department of Health’s Payment by Results Team which offered immense help and coordinated the work to make the idea of developing national guidance, a reality.

Dr Mahmood Adil CerHEcon, DipHInformatics, FRCP, FFPH, DipIoD National Advisor for Clinical and Finance Engagement Department of Health

–  –  –

1. Introduction

1.1 Effective engagement between clinicians and finance professionals is the key to improving value in the current financial environment. It must be embedded within each healthcare organisation’s culture and practices and considered an important element of any high performing, patient-centred organisation.

1.2 In today’s NHS, organisations can only deliver effective patient care within available resources by creating an environment where working relationships between clinicians and finance teams are thriving. Clinicians are responsible ultimately for the way in which services are delivered and for committing resources. They can only do this effectively with input from finance colleagues. For instance, through sharing cost and patient outcomes data for better informed decision making.

1.3 It is clear that cost reductions without maintaining or improving outcomes may amount to false savings and have a detrimental effect on the delivery of effective patient care.

Therefore it is essential that effective engagement takes place at every level to ensure that all members of the team are focused on delivering high quality and affordable care for patients.

Purpose

1.4 The purpose of this guide is to enable individuals and teams to take a systematic and objective approach to improving the levels of engagement between clinical and financial colleagues in provider organisations. It is written with a focus on NHS provider healthcare organisations although the concepts are not exclusive to this sector.





1.5 The guide defines the different levels of clinical and financial engagement which are present in the current NHS system, highlighting the characteristics and behaviours of organisations with high engagement, presenting a self-assessment tool to help NHS trusts assess their current level, and provide best practice examples.

1.6 The guide is in alignment with many of the lessons identified in the Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry by Robert Francis QC. The Francis report identified a culture of ‘silo working’, poor cost control and poor patient care which caused patient safety to be compromised. Its recommendations are designed to change this culture through implementing fundamental standards and measures of compliance which are defined in genuine partnership with patients, the public and healthcare professionals.

6 A Guide to Effective Clinical and Financial Engagement

1.7 The emphasis on working in partnership to deliver improved patient services is one of the key lessons of the Francis report and is reinforced here. More broadly, evidence of high levels of engagement between clinical and finance professionals will help trusts in their reviews by the Chief Inspector of Hospitals.

1.8 The Francis report’s recommendations which relate to effective engagement between clinical and financial professionals are highlighted in Annex C.

Research

1.9 We have used two important strands of research to inform this work:

• The first is the Department of Health’s annual reference costs collection and surveys of 2012 and 2013, which provide the current levels of engagement in the NHS. These are covered in Chapter 2 and provide the national position.

• The HFMA Clinical-Financial Engagement Survey – Finance Leaders (Autumn 2011) and the HFMA Clinical-Financial Engagement Survey – Clinicians (Spring 2012), covered in Chapter 3, provide the views of senior clinicians and finance directors.

These have been used to develop the key characteristics of effective engagement.

Guide development

1.10 This publication has been developed in consultation with many NHS provider trusts and national organisations whose support, ideas and input have been pivotal to the process.

These include: the HFMA; Monitor; Audit Commission; NHS Trust Development Authority; NHS England; Care Quality Commission; Royal College of Nursing; Academy of Medical Royal Colleges; General Medical Council; and Medical Schools Council.

1.11 We also wish to acknowledge the work of organisations which have highlighted the importance of engagement between clinicians and finance professionals in their reports

and publications over recent years:

• December 2007: A Prescription for Partnership: Engaging clinicians in financial management – Audit Commission

• February 2009: Clinicians and Finance: Improving patient care – Joint statement by the HFMA, Audit Commission, Department of Health, NHS Institute for Innovation and Improvement, Royal College of Nursing and Academy of Medical Royal Colleges

• July 2009: A Guide to Finance for Hospital Doctors – Audit Commission and Academy of Medical Royal Colleges

• November 2010: Agents for Change: Collaborating for quality – The King’s Fund, BMJ, NHS Confederation and Department of Health

• November 2012: Clinical-Financial Partnerships in the NHS: Why we need them to deliver the cost and quality challenge – NHS Institute for Innovation and Improvement.

–  –  –

2. Definitions and benchmarking

2.1 To make use of this resource, organisations first need to understand the frames of reference and share them internally. This will ensure there is clarity to guide the process.

2.2 We are using simple but clear definitions for the terms ‘clinicians’ and ‘engagement’:

• Clinicians – this covers the full range of clinical staff working with the NHS, including medical, nursing, pharmacy, allied health professional and others.

• Engagement – is defined as mutual understanding and cooperation between different professions/cultures leading to joint working.

The four levels of clinical and financial engagement

2.3 A second key frame of reference is to make an assessment of the current position within an organisation through being able to classify its levels of engagement and understand how it is operating. This is done by using the self-assessment tool which we developed for this purpose (see Chapter 4). It is based on four levels of clinical and financial engagement and provides a framework for organisations to assess their position.

2.4 The four levels were originally proposed by the National Advisor for Clinical and Financial Engagement at the Department of Health and colleagues across many NHS trusts were involved in their further development.

–  –  –

Current national position 2.5 The Department of Health collects data on levels of engagement between clinicians and finance professionals from all NHS trusts via the annual reference costs survey. The results show the current position across the four levels of engagement for the NHS and provide a national benchmark which can be used alongside local benchmarks.

–  –  –

80 70 56 60 49 2011/12 50 2012/13 40 30 20 20 7 10

–  –  –

3. Characteristics of effective engagement

3.1 Organisations have told us they would like a clear picture of ‘what good looks like’ when it comes to effective engagement between clinicians and finance professionals. We have found that those organisations which are succeeding in this challenge generally display a set of key characteristics.

Scoping the characteristics

3.2 These characteristics were initially scoped by conducting national research with clinicians and finance professionals. Two surveys were held by the Department of Health and HFMA: the HFMA Clinical-Financial Engagement Survey – Finance Leaders (Autumn

2011) and the HFMA Clinical-Financial Engagement Survey – Clinicians (Spring 2012).

The response rates were 58% and 44% respectively.

3.3 The highlight of the surveys was the clear recognition of the importance of engagement between the two professions: 98% of clinician respondents and 96% of finance director respondents said they believed that high quality services would only be affordable if clinical and finance colleagues are properly engaged to achieve the desired outcomes together.

3.4 Other results which were used to inform the development of the characteristics are:

The top three barriers which need to be overcome, according to clinicians:

• Lack of basic financial awareness/skills among clinicians

• Lack of robust cost data

• Poor presentation of financial and clinical data.

The top three barriers which need to be overcome, according to finance leaders:

• Variability of cost and income data

• Lack of robust cost data

• Lack of basic financial awareness/skills among clinicians.

The top five local measures to improve engagement, according to clinicians:

• Introduction/greater use of patient-level costing

• Wider adoption of service line management (SLM)

• Clear incentives/penalty for achievement or non-delivery of both quality and cost improvement

–  –  –

• Requiring non-finance staff to undertake an introductory course in NHS finance

• Formal programme of job shadowing between finance and clinical leads.

The top five local measures to improve engagement, according to finance leaders:

• Clear incentives/penalty for achievement or non-delivery of both quality and cost improvement

• Introduction/greater use of patient-level costing

• Wider adoption of SLM

• Formal programme of job shadowing between finance and clinical leads

• Regular open access finance surgeries for clinicians, budget holders and other frontline staff.

Finally both groups cited the same reasons for good engagement where it happens:

• Availability of good data

• Clinical champions

• Finance champions

• Shared vision and culture.

3.5 The full survey results can be viewed on the HFMA’s website at: HFMA engagement surveys.

Key characteristics of effective engagement



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